A Tommy John Surgery is a surgical procedure in which the ulnar collateral ligament (UCL), a key ligament in the elbow, is replaced with a tendon from elsewhere in the body. This surgery is performed when the UCL starts to fail, and it is classically used on athletes, because they tend to damage this ligament more than other people, and a damaged UCL can be a career-ender. Baseball players are most likely to need UCL surgery, especially if they are pitchers.
Properly, this surgery is known as an ulnar collateral ligament reconstruction. It's called a Tommy John Surgery after the first patient to receive the surgery, who pitched for the Los Angeles Dodgers. In 1974, Doctor Frank Jobe reconstructed Tommy John's damaged UCL, and he went on to have a very successful pitching career. In the years since then, the surgery has been refined, becoming much more effective and much less invasive.
In the Tommy John Surgery, the surgeon opens the elbow up, removes the damaged ligament, and drills a series of holes in the bones around the elbow. A tendon is harvested from elsewhere in the body, often the forearm, and threaded through the holes, essentially tying the elbow together. The wound is closed, and the patient is in for about a year of recovery, including physical therapy to encourage the harvested tendon to ligamentize, pulling the bones together and stabilizing the elbow.
It is possible to achieve a full recovery after a Tommy John Surgery, and the surgery has become increasingly common. Often, people appear to perform better after the surgery than they did before, although doctors have suggested that the surgery probably brings the elbow back to peak condition, so athletes are really just performing like they used to before their UCLs were damaged. Recovery also involves a lot of careful conditioning and a slow return to demanding physical activity, and this mandatory resting period is undoubtedly beneficial.
In the 1990s, doctors began to observe a disturbing rise in the use of the Tommy John Surgery among high school athletes. They suggested that high school athletes were being overworked and overstrained, because younger bodies are typically able to withstand harder training regimens, so an athlete's schedule would have to be quite grueling for a problem with this ligament to develop. Like any surgery, the Tommy John Surgery also carries risks, and some doctors are reluctant to see it performed on young athletes for that reason as well.